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A very rare side effect of prazosin is priapism. [3] [21] One phenomenon associated with prazosin is known as the "first-dose response", in which the side effects of the drug — specifically orthostatic hypotension, dizziness, and drowsiness — are especially pronounced in the first dose. [3]
High doses of the α 1 blocker, prazosin, have been efficacious in treating patients with PTSD induced nightmares due to its ability to block the effects of norepinephrine. [ 27 ] Adverse effects of prazosin to treat PTSD nightmares include dizziness , first dose effect (a sudden loss of consciousness), weakness , nausea , and fatigue .
The risk of first dose phenomenon may be reduced or eliminated by gradual-dose titration, since the adverse effects of Prazosin are dose-related. [7] This is also the case for Tamsulosin and it may be assumed that the others alpha-1 blockers work in a similar manner, since Tamsulosin is an alpha-1-a blocker and Prazosin is an alpha-1 blocker. [30]
Prazosin would significantly decrease the number of PTSD related nightmares and would therefore improve sleep quality. [12] However, only few studies considered the effect of Prazosin in idiopathic nightmares. [12] Benzodiazepines are also often used to treat nightmare disorder, despite the lack of efficacy demonstrated in empirical studies. [12]
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Prazosin (Minipress) for nightmares: prazosin is approved for the use of hypertension. A 2012 systematic review showed a small benefit for the treatment of PTSD-associated night terrors. Other non-FDA-approved uses for prazosin include the treatment of Raynaud's disease and poisoning due to scorpion venom.
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